The CHIPRA quality demonstration grant program was an ambitious Federal effort to evaluate promising strategies for improving quality of care for children enrolled in Medicaid and CHIP. States implemented a wide array of projects that provided examples of such strategies, many of which will be sustained and spread after the demonstration has ended. These projects underscore the importance of marshaling resources over several years to enhance the capacity of States to report and use quality measures, address the thorny problems of implementing new health IT applications, and develop the stakeholder relationships that underpin successful efforts to transform service delivery systems. Challenges in assessing the impact of these projects emphasize the need to both embed evaluation considerations in designing grant programs and enhance access to the administrative and claims data needed to assess quality of care for populations enrolled in Medicaid and CHIP.
Overall, findings from the evaluation of the grant program provide policymakers at the Federal and State levels with a strong foundation for considering next steps to improve quality of care for children enrolled in Medicaid and CHIP. For example, CMS could build on demonstration States’ successful experiences in developing their capacity for reporting and using the Child Core Set of quality measures, possibly by supporting other States in replicating these capacity-building strategies or incorporating lessons learned in future TA efforts. As Federal and State policymakers develop new efforts to stimulate innovation in service delivery systems, they could look to the outcomes of this demonstration for ideas about pathways to further explore (and to avoid). In sum, results from the demonstration grant program and its national evaluation suggest numerous strategies that can inform future policy development and new grant-making programs to improve care for children.
